good with details photos of fundus, retina seen in day to day practice by direct or indirect ophthalmoscopy

1. ANATOMY OF THE RETINA
• The retina lines roughly 76% of the globe. It extends up to the
ora serrata anteriorly and terminates at the optic nerve
posteriorly.
• The central retina is an area approximately 5 to 6 mm in
diameter centered on the fovea that contains the foveola,
fovea, and macula.
• The peripheral retina is divided into the near periphery,
midperiphery, far periphery, and ora serrata.

2. umbo
Parafovea (0.5 mm)
Perifovea(1.5 mm)
Macula (5.5 mm)
Fovea (1.5 mm)
Foveola(0.35 mm)

4. • Clinically the peripheral retina is defined as the zone from
the equator to the ora serrata and is approximately three to
four disk diameters in width.
• The vortex veins represent the equator.
• a 1.5-mm ring peripheral to the temporal major vascular
arcades called the near periphery.
• The retina around the equator is called the equatorial retina,
and the region anterior to it is called the peripheral retina

5. • The midperiphery consists of an annular area 3 mm wide
surrounding the near peripheral retina.
• The far peripheral retina extends in width 9 to 10 mm beyond
the midperipheral retina temporally and 16 mm nasally.

6. Examination
• Photograph of a normal
disk.
• Points to note while
examining the disk are its
• color,
• margins,
• the cup,
• neuroretinal rim,
• the vessels and
• the peripapillary area

7. • Normal arterioles and
venules.
• The arterioles are thinner,
red in color and show a
prominent golden reflex.
• The venules are broader,
flatter, and darker red in
color.
• The arterioles and venules run alongside each other for some
distance and their branches often cross each other

8. • At arteriovenous crossings
the arterioles may cross
over the venules
• or the venules may cross
over the arterioles
• Though the former is more
common

9. • The retina has an orangish
color which varies with the
degree of pigmentation in
the pigment epithelium.
• Some normal variations of
the pigment in the RPE can
allow the orange stripes of
choroidal vessels to be
seen giving it a tigroid
appearance.
• These vessels are better seen in the mid-periphery and beyond.
• Choroidal vessels seen as orange tape like criss-crossing bands

10. The ampulla of a vortex vein is seen as an orange bulb with choroidal veins
draining into it

11. • Junction between the temporal ora
serrata and the pars plana
• the nasal retina has more prominant
dentate processes than the temporal
retina

12. Variations of normal optic nerve head
A normal disk in which the cup
cannot be appreciated
A normal disk with a small cup

13. Physiologically enlarged cup
showing a uniform thinning of the
entire neuroretinal rim
A normal disk with blurred margins
and absent cup giving a false
impression of disk edema

14. A hyperemic disk with
a small cup and
blurred margins in a
hypermetropic eye
Blurring of the disk margins (initially
the superior and inferior) with absent cup
raises suspicions of early papilledema.
Presence of venous pulsations or the ability
to induce them, suggests absence of it.

15. • papilledema characterized by a hyperemic protuberant disk with blurred margins and
obscured cup.
• The blood vessels on the disk appear to climb down from the elevated margins towards the
surrounding retina and at places appear to be hidden by the swollen fibers.
• The veins of the retina are engorged.
• There is surrounding peripapillary edema

16. Established papilledema with
blurring of the entire margin of the
optic disk with some elevation,
dilated turgid and
tortuous veins, soft exudates and
few retinal hemorrhages
Chronic papilledema with blurring
of the entire margin of an elevated
optic disk with deposition of hard
exudates

17. Arteriosclerotic changes seen as
increased reflex from the wall of the
arterioles making them appear as silver
wires
In hypertensives the vessels may
become tortuous

18. In Hypertensive optic neuropathy, optic nerve head edema is present
along with other signs of hypertensive retinopathy—retinal
hemorrhages, cotton-wools spots, macular edema, macular star,
arteriovenous crossing changes. These changes are bilateral

19. In diabetic papillopathy, unilateral or more commonly bilateral
hyperemic swollen disks maybe present in association with mild to
moderate visual loss. Other changes of diabetic retinopathy may be
absent.

20. • Hyperemic disks with blurred margins in patients, who have been
addicted to alcohol and tobacco over a prolonged period of time,
must be suspected to have (tobacco-alcohol) toxic optic neuropathy.
• The disk swelling is less and the vascular changes of papilledema are
not seen.
• Later in the course of the disease the disks become pale and
excavated.
• A dramatic and bilateral loss of vision with bilateral swollen
hyperemic disks along with marked attenuation of the blood vessels
maybe seen in methyl alcohol poisoning.
• These disks rapidly turn pale. In the majority, by the time the patient
presents the disks are invariably pale.

21. • Bilateral hyperemic disks with blurred margins may be seen in young
patients, usually male, in Leber’s hereditary optic neuropathy.
• The optic disks look hyperemic with tortuous and telangiectatic
vessels and blurred margins. However, the disk prominence is mild.
• A peculiar swelling of the fibers around the disk has also been
described (pseudoedema). The two eyes are involved in rapid
succession which then proceeds to optic atrophy
• Patients on chronic therapy with the antiarrhythmic drug
Amiodarone may develop an optic neuropathy showing hyperemic
disks with blurred margins.
• The cornea shows superficial brown deposits of the drug in
characteristic whorls.

22. • Hyperemic swollen disks are the hallmark of optic neuritis which is
usually unilateral in adults but can be bilateral in children.
• If it is associated with paraplegia or other neurological defects that
may occur before or after the optic neuritis it is likely to be
neuromyelitis optica.
• Bilateral optic neuritis in adults is rare and usually associated with
extensive sinusitis and syphilitic meningitis.

23. Glittering yellow deposits of synchiasis
scintillans which fly around within the
liquefied vitreous. At rest, they settle down
only to be scattered like a ‘golden shower
‘with the next eye movement
Multiple small yellowish- white deposits of
Asteroid hyalosis suspended in a formed
vitreous gel and hence move very little with
movements of the eye

24. • Mild optic disk edema associated with retinal
edema and hard exudates deposited as and
incomplete macular star in Neuroretinitis.
• The disk edema is relatively milder than in
optic neuritis and the macular star appears
early
• Long standing neuroretinitis showing
features of chronic disk and macular
edema, resolving macular star, dilated
epipapillary vessels and retinal striae
(Paton’s lines)

25. Optic nerve meningiomas distorting
the globe and causing inferior disk
edema
Hyperemic disk edema associated with
posterior uveitis (Vogt Koyanagi Harada
syndrome).
Multiple patches of choroiditis are seen
at the posterior pole

26. Patches of active choroiditis seen as moderate sized yellow lesions
with fuzzy margins. Several pigmented healed scars are also present

27. Progressive cytomegalovirus retinitis
with some retinal hemorrhages and
vasculitis
CMV retinitis in the peripapillary
region with involvement of the optic
nerve head

28. • Healed CMV retinitis leaving an area
of atrophic retina. The vessels are
sclerosed
• The atrophic retina easily develops
atrophic holes frequently resulting in
rhegmatogenous retinal detachment

29. • An extensive lesion comprising of fluffy dense whitening of the retina with scattered retinal
hemorrhages CMV retinitis (fulminant form). This appearance is called a ‘pizza pie’ or
‘cottage cheese with ketchup’ appearance. The lesions are sharply demarcated with small
isolated satellite lesions at the advancing edge. The retinitis often occurs first in relation to the
vessels of the posterior pole as one or more foci which then coalesce and progress.
• The unaffected retina looks normal

30. • Large confluent, yellow white, granular looking areas in acute retinal necrosis (ARN). The
patches appear granular and are more deeply placed. Initially the disease process starts as
multiple small lesions in the mid-peripheral retina that coalesce and spread towards the
periphery as well as posteriorly.
• The macula remains spared till late

31. Deep retinal opacification present all around in the mid-peripheral retina with characteristic
clearing of the retinal opacification around the blood vessels (perivenular) (black arrows) giving a
‘cracked mud’ appearance in progressive outer retinal necrosis (PORN)

32. White, cobweb like subretinal fibrosis secondary to long standing
choroiditis

33. Bilateral, subretinal gliotic sheets that have rapidly encompassed the
entire posterior pole, suspicious of subretinal fibrosis and uveitis

34. Multiple scars of variable size scattered
randomly anywhere in the retina
following multifocal choroiditis
Patches of healed choroiditis can
vary in their appearance (here there
is no pigmentation and the lesions
are confluent)

35. Hyperemic disk edema
associated with central retinal
vein occlusion
Papillophlebitis. There are multiple
soft exudates, some hemorrhages
and patches of retinal edema
especially in the inferior retina

36. • Optic nerve head studded with
refractile globular deposits of varying
size that reflect light brightly, in a
patient with optic nerve head drusen
• The drusen exhibit autofluorescence.
• This feature clinches the diagnosis

37. • A pale swollen disk in
anterior ischemic optic
neuropathy (the fuzzy
looking swollen tissue
along with pallor gives
the disk a ‘milky
appearance’). On FFA
the disk shows patches
of hypoflourescence
due to nonperfusion
(arrows)

38. • Atrophy of the papillomacular bundle results in
temporal pallor and commonly occurs following
retrobulbar neuritis and bilaterally in pituitary
tumors.
• A band or bowtie pallor with sparing of the
superior and inferior parts of the disk implies
optic tract involvement.

39. • ‘Disk at risk’ is a disk that is crowded with nerve fibers that
decrease the size of the cup.
• Such disks are predisposed to anterior ischemic optic neuropathy.
The other eye of this patient has earlier suffered an ischemic optic
neuropathy.

40. • In patients with acute
lymphocytic leukemia,
lymphocytic infiltration of the
retrolaminar portion of the optic
nerve results in a pale disk
edema. Presence of whitish fluffy
infiltrates on the surface of the
disk, obscuring its details is
suggestive of prelaminar
infiltration.
• Similar infiltration may occur in
lymphoma, metastatic
carcinoma, and
nasopharyngeal carcinoma

41. • Waxy yellow pallor of the disk with
attenuated arterioles and bone
corpuscle shaped pigment deposits
(consecutive Optic atrophy
secondary to Retinitis Pigmentosa)
• Pigment clumping seen in the posterior pole,
bilaterally, with minimal pigment disturbance in
the peripheral retina in inverse RP or pericentral
retinitis pigmentosa.
• The arterioles are attenuated and the disk shows a
waxy pallor. The features are present bilaterally

42. • classic ‘bone corpuscle’
shaped pigmentation in
retinitis pigmentosa
• Attenuation of the retinal vessels
along with a fine mottling of the
RPE in the mid-peripheral retina but
no discernible pigment clumping
referred to as retinitis pigmentosa
sine pigmento

43. Sparing of the macula inspite of
extensive involvement of the mid-
peripheral retina in retinitis
pigmentosa classic ‘bone corpuscle’
shaped pigmentation in retinitis
pigmentosa
Geographic atrophy of the macula in
retinitis pigmentosa

44. Multiple small white spots in the mid
peripheral retina with an atrophic patch
at the macula and attenuated arterioles in
retinitis punctata albescens
Densely packed multiple yellow
white spots of fundus albipunctatus
in a patient complaining of night
blindness.

45. • A total lack of chorioretinal pigment in albinism resulting in a completely
hypopigmented fundus. All levels of the choroidal vessels are visible. The fovea
is indistinct
• There is complete lack of pigment till the retinal periphery

46. Almost complete atrophy of the
choroid with only small patches of
intact choroid, seen in an elderly male
is likely to be the end stages of
choroideremia
FFA highlights the small island of
normal choroidal tissue remaining at
the macula

47. • Highly enlarged disk bearing a coloboma
• Morning Glory anomaly wherein the optic disk appears
to be embedded in the center of a funnel shaped
excavation of the entire peripapillary region. The disk is
covered with varying amounts of grayish white glial
tissue which envelops the retinal vessels.
• The vessels are greater in number and arise more
peripherally. They are abnormally narrow and straight,
spreading radially giving the appearance of the ‘morning
glory flower’. The abnormal disk is surrounded by a halo
of chorioretinal atrophy.

48. Size of the coloboma can vary (a small
choroidal coloboma)
A large coloboma involving the disk
and macula

49. • Melanocytoma of the optic nerve head
appearing as a black mass obscuring the
disk
• Linear hemorrhages in the shape of splinters
of wood on the disk surface are called Splinter
hemorrhages and are characteristically found
in
> uncontrolled glaucoma,
> anterior ischemic optic neuropathy,
> central retinal vein occlusion

50. • A choroidal nevus present
inferotemporal to the disk, seen as
an ill-defined, deeply located,
pigmented lesion.
• The margins of the nevus are
feathery
• Dark pigmented lesion on the optic
nerve head (Melanocytoma)

51. • New vessels on the disk (NVD) appear as
a network of fine vessels arborising on
the surface of the disk- the rest of the
retina shows features of the underlying
disease such as retinal hemorrhages,
exudates
• Collaterals on the optic disk appear as
small clumps of vessels that are tortuous
and curly

52. • A choroidal melanoma seen as a brown, elevated, globular mass below the
retina

53. • Feathery white patches fanning out
from the optic disk on to the retinal
surface following the pattern of the
nerve fibers is likely to be a patch of
myelinated nerve fibers—they can
vary greatly in their extent
• Small grayish wisp of tissue
attached to the disk surface is likely
to be an embryonic remnant of the
hyaloid system referred to as a
Bergmeister’s papilla

54. • Persistent hyperplastic primary
vitreous is seen as a membrane
that fans out from the optic nerve
head extending anteriorly and is
often associated with a fold of the
retina

55. • Fibrovascular proliferation on the
optic disk look like grayish white
membranes situated on the disk
surface and growing into the vitreous.
Proliferating vessels are seen within
the membrane. These vessels can
disappear as the proliferation
regresses leaving a sheet of dense
fibrous tissue.
• The rest of the fundus shows features
of the causative retinal pathology

56. • A small, oval disk that is abnormally tilted
such that the long axis of the disk lies
obliquely is called a tilted disk.
• There is thinning and hypopigmentation of
the inferonasal retinal pigment epithelium
and choroid
• A severely tilted disk in which the disk appears
to be almost horizontally placed.
• Obliquity in the anteroposterior axis causes the
disk to look small as seen ‘end on’

57. • Grayish looking thickened macula
with cherry red spot due to
ischemic macular edema in a
patient with central retinal artery
occlusion
• The patient also had advanced
glaucomatous cupping of the disc
• Glassy appearance of an edematous
macula in a patient with small branch
vein occlusion.
• There are several retinal
hemorrhages and the edematous
area is bordered by hard exudates

58. • Multiple, small, ‘red colored’ cysts arranged in a
rosette around the fovea is the characteristic
appearance of cystoid macular edema
• It is commonly seen postoperatively after
cataract surgery or in association with
uveitis,
central retinal vein occlusion,
diabetic retinopathy,
retinitis pigmentosa or
with a choroidal neovascular membrane
• Bilateral CME may occur in association with pars
planitis and the use of certain drugs such as
latanoprost, epinephrine, nicotinic acid,
tamoxifen.

59. • A star shaped radial arrangement of linear
yellow hard exudates centered on the
fovea called a ‘macular star’ seen in a
patient with neuroretinitis
• A complete macular star along with retinal
hemorrhages, soft exudates and disk
edema in Grade 4 hypertensive retinopathy

60. • A well circumscribed round to oval area
of neurosensory elevation centered at the
fovea in central serous chorioretinopathy
(CSCR)
• A small CSCR can be easily overlooked

61. • Deposition of subretinal fibrin within the
cavity of CSCR

62. • Retinal pigment epithelial alterations at the macula and as a linear
track (arrow) below the macula called ‘CSCR tracks’.
• These lesions are better seen by FFA as transmission defects (arrow)

63. • A small, well defined area of retinal
elevation looking like an ‘orange blister’
is the characteristic appearance of a
pigment epithelial detachment
• A moderate sized pigment epithelium
detachment

64. • Thickened macula along with subretinal
hemorrhage due to an underlying
choroidal neovascular membrane
• Subretinal blood that is darker in color
with well defined margins suggests that
the blood may be below the pigment
epithelium

65. • Presence of a subretinal grayish green
membranous lesion that resembles a wet
tissue and thickens the macula unevenly
is likely to be a choroidal neovascular
membrane (CNVM).
• The thickening is also due to the presence
of the membrane, serous elevation of the
retina and intraretinal edema.

66. • Scar consisting of subretinal gliosis,
pigmentation and chorioretinal
anastamoses secondary to a choroidal
neovascular membrane
• Scar consisting mainly of white retinal
gliosis with no pigmentation

67. • Some scars have characteristic features
which help to identify the cause.
• Scars following congenital toxoplasmosis
have a predilection for the macula causing
a focal necrotizing retinitis.
• But most of these lesions are detected at
a later stage when the macula shows a
deep punched out pigmented scar.
• Active toxoplasmosis with significant
vitreous inflammation ‘headlight in fog’
appearance

68. • Scars following choroidal tear appear as
multiple curved linear scars concentric to
the disk margin.

69. Patch of retinitis adjacent to an old scar
suggests the possibility of
toxoplasmosis. The vitreous may show
cells specially overlying the active
lesions
A focus of active retinitis looks like a
fluffy white
lesion as the involved retina becomes
thickened, elevated and edematous

70. Scars secondary to a posterior pole toxocara granuloma also have a
characteristic appearance

71. • Wrinkles (fine retinal folds) across the
macula in a patient with a shallow
retinal detachment
• A better defined ERM causing tortuosity
of the blood vessels and ILM folds

72. • A contracting epiretinal membrane can cause
the clivus to be drawn towards the center
deepening the foveal depression. This causes
the fovea to look darker red and when seen in
contrast to the whitish membrane it can
falsely look like a macular hole, actually a
pseudohole
• A macular hole is seen as a circular or oval
almost punched out red colored defect in the
macular tissue with a gray well defined edge

73. • Fluid that seeps in through a full
thickness macular hole appears as a cuff
of subretinal fluid around the hole
• A large macular hole with urrounding
cuff of fluid

74. • A macular cyst can be mistaken for a
macular hole
• A pseudohole due to an epiretinal
membrane can be mistaken for a macular
hole

75. Horseshoe retinal tear appears as a red
colored ‘V’ shaped break in the retina,
looking like a piece of cloth that is torn when
caught in barbed wire
Retinal hole with surrounding subretinal
fluid

76. Difficult to see large horseshoe tear that can easily be missed on cursory
examination. Such tears are better visualized by indentation

77. A giant retinal tear with retinal detachment and a ‘rolled out’ edge

78. Gray dome like elevation of the retina in
the peripheral retina commonly in the
inferotemporal quadrant and bilateral is
likely to be peripheral retinoschisis
Fibrovascular fronds causing tractional
retinal detachment

79. The peripheral retina looks grayish and elevated with a well defined linear posterior edge
due to indentation by a scleral buckle—‘the buckle effect’

80. In a retinal dialysis the retina appears to be disinserted from the ora and there is
no retinal tissue between the break and the ora

81. Snowflake degeneration appears as tightly packed small white specks looking like snowflakes
scattered in the peripheral retina

82. • A well defined red lesion at the macula
due to the presence of a post traumatic
macular hemorrhage (subretinal). There
is another patch of subretinal
hemorrhage nasally
• Massive ‘subretinal’ hemorrhage, fresh
(red) and altered (decolored)

83. • An area of subretinal hemorrhage
can appear as a dark blackish-
maroon lesion of the fundus
mimicking pigmented lesions.
• Dark subretinal blood with areas of
white altered blood at the macula

84. • Normally at an AV crossing the
venule crosses the arteriole obliquely
but with arteriolar sclerosis the
venule is seen to be deflected in such
a manner that it crosses the arteriole
at right angles (Salus sign)
• All caliber changes occurring at
arteriovenous crossings are
collectively referred to as ‘AV
nicking’ seen here at multiple sites
(arrows)

85. Compression of the vein (arrow) results in an
apparent impediment to the flow of blood in the vein across the crossing resulting
in ‘banking’ and swelling of the peripheral part of the vein (Gunn’s sign)

86. • Multiple ‘intraretinal’ macular
hemorrhages following a branch vein
occlusion
• Preretinal macular hemorrhage obscures
the underlying retina

87. Sheathing of a vessel with an
adjacent patch of retinal hemorrhage
due to active vasculitis
A sheathed occluded vessel as a result
of old vasculitis

88. Active vasculitis with perivascular infiltration and adjacent retinal hemorrhages

89. Resolving vasculitis with decreasing perivascular infiltration, retinal
hemorrhages and retinal edema

90. • Frosted branch angiitis is a severe form of vasculitis that affects almost the
entire vasculature.
• The profuse perivascular infiltration causes the blood vessels to look like
frosted branches

92. • Cherry red spot secondary to traumatic
macular edema (Berlin’s edema)
• Post-traumatic edema (Berlin’s edema) involving
large areas of the retina along with retinal and
subretinal hemorrhage.
• This type of opacification is usually at a deeper
level of the retina and is well defined and more
glistening. There is associated macular edema,
choroidal tears and subretinal hemorrhage

93. • Prominent choroidal folds in a patient
with choroidal effusion syndrome
• Sharply demarcated areas of atrophic
pigment epithelium and choriocapillaris
uncovering the larger choroidal vessels in
central areolar choroidal dystrophy

94. • Bulls eye maculopathy secondary to
chloroquine toxicity—early changes
include stippling or mottling and blunting
of the foveal reflex.
• Later there is central irregular
pigmentation surrounded by a concentric
zone of hypopigmentation
• Bulls eye maculopathy seen in a patient
with advanced cone dystrophy.
• A pigmented area in the center is
surrounded by a complete or incomplete
parafoveal ring of depigmentation

95. • Lattice (reticular/net) like pattern at the macula in the rare Sjogren’s
reticular dystrophy

96. • Bilateral pigment mottling in a glistening,
orizontally ovoid area giving a metallic beaten
bronze appearance is highly suggestive of
Stargardt’s disease.
• The mottling can occupy an area of 2 disk
diameters.
• A ring of yellow flecksoften surrounds this
area. The flecks are peculiarly shaped and are
curved esembling fish or comma or crescent
like shapes.
• They can extend up to the mid peripheral
retina but never beyond. These changes are
then referred to as fundus flavimaculatus.

97. In fundus flavimaculatus the yellowish flecks are in small curvilinear shapes
resembling commas or small fish occurring bilaterally and symmetrically in the
posterior pole up to the midperiphery. Patches of RPE atrophy at the macula
(Stargardt’s dystrophy) maybe present

98. • In the initial stages of the
disease the fovea shows a
granular appearance and
gives the impression of
being covered by a
varnish.
• These changes are picked
up earlier by FFA which
shows a mottled hypo and
hyperfluorescence.
• Fundus flavimaculatus, if
present shows
characteristic ‘choroidal
silence’ on FFA in which
the choroidal circulation is
masked and the retinal
capillaries stand out in
contrast

99. • Patch of pigmentation just temporal to the fovea bilaterally, seen in
late stages of Idiopathic macular telangiectasias (also called
parafoveal or juxtafoveal telangiectasias)

100. • Bilaterally symmetrical idiopathic macular telengiectasia (IMT) also called juxtafoveal or parafoveal
telengiectasia.
• The capillaries in this area exhibit mild irregular dilatation with adjacent graying due to edema of the
surrounding retina.
• On FFA the parafoveal vessels are dilated and telangiectatic and leak gently in the late phases especially in the
temporal network

101. Retinal edema, crystalline deposits and
dilated ectatic vessels seen in the
temporal parafoveal region suggestive of
idiopathic macular telangiectasias
(formally referred to as idiopathic
juxtafoveal telangiectasias/parafoveal
telangiectasias)

102. • small red dots scattered across the
posterior pole are likely to be
microaneurysms (black arrows)
whereas retinal hemorrhages are
usually larger (white arrow)
• Often a bunch of microaneurysms
are seen at the center of a ring of
retinal thickening and hard exudates
(circinate girdle)

103. • Punctate or rounded
hemorrhages, looking like ‘dots
and blots’ are hemorrhages in
deeper layers of the retina
• Preretinal hemorrhages (arrow head)
• multiple ‘Roth’s spots (arrows) in
anemic retinopathy

104. Venous reduplication (black arrow) is
a sign of increasing retinal ischemia
as seen in severe NPDR along with
other signs such as soft exudates and
retinal hemorrhages in multiple
quadrants
A network of arborising or broom like
vessels lying superficially on the disk
or on the retinal surface is suggestive
of neovascularisation

105. NVE form at the junction of ischemic
and non-ischemic retina
New vessels growing in a radial pattern
also referred to as ‘sea-fan’
neovascularization.

106. Over time, delicate fibrous tissue becomes
evident along the new vessels. Initially
this tissue is translucent but later it
becomes opaque and white and the
complex is now referred to as a
fibrovascular proliferation (FVP)
Traction from a detaching posterior vitreous can
cause a fibrovascular frond to bleed resulting in
vitreous hemorrhage

107. A contracting fibrovascular frond is
seen to exert traction at its points of
attachment to the retina causing a
drag on the retinal vessels
NVD fanning out into the vitreous body

108. • Multiple, round white spots, that
are regularly spaced, in a specific
pattern due to recent laser
application
• Photocoagulation scars appear as
multiple, regularly arranged, circular
scars scattered in a pattern

109. Multiple cotton-wool spots, retinal
hemorrhages, disk edema in the
posterior pole seen in hypertensive
retinopathy
Boat-shaped sub-hyaloid
hemorrhage

110. • Angioid streaks (breaks in the Bruch’s membrane) seen as dark red
lines radiating from the optic disk in all directions that lie deep in the
retina and resemble cracks

111. • The breaks allow the choriocapillaris to show through. They are
associated with mottling of the RPE at the macula

112. • Rounded, sharply demarcated, yellowish
white areas with varying amounts of
pigmentation seen in a myopic eye represent
focal areas of chorioretinal atrophy in
myopia
• As the choriocapillaris atrophies the larger
choroidal vessels are seen to cross these
areas
• Criss-crossing yellow colored choroidal
vessels at the macula due to choroidal
sclerosis. A ‘laquer crack’ seen as a fine linear
reddish line is also present

113. Geographical patches of chorioretinal atrophy exposing the underlying
sclera in severe degenerative myopia

114. • The cracks in the Bruchs membrane allow the growth of fine choroidal
neovascular membranes which become more obvious when they bleed.
• These blotches of hemorrhages are often referred to as Fuchs’ spot and rapidly
disappear leaving an area of pigmentation and scarring.

115. • Multiple yellow, pale or white punctate round deposits of varying size at the
posterior pole (drusen)

116. • Small (less than 63 microns) flat
drusen with well defined margins
are called hard drusen
• Large drusen (greater than 125
microns) with less distinct, fuzzy
margins that are elevated or dome
shaped are called soft drusen.
• They tend to become confluent in
various shapes as they coalesce

117. Still larger confluent, soft drusen (500
microns) may have a pool of serous
fluid around them and are referred to
as drusenoid PEDs (Drusenoid
pigment epithelial defects)
Regressing drusen are whiter and
refractile in appearance. Their margins
become irregular and areas of
calcification start to appear. Associated
RPE atrophy becomes prominent

118. • Sharply demarcated, round to oval area of depigmentation, showing the
underlying choroidal vessels is an area of geographic atrophy in Dry AMD

119. • A sharply demarcated hypopigmented spot due to loss of pigment from the retinal
pigment epithelium may be a result of exposure to ultraviolet rays (photic
retinopathy).
• At times there maybe clumps of pigment adjacent to the hypopigmented lesion.
• If examined soon after exposure the fovea shows a focal whitish gray lesion
resembling a photocoagulation spot of varying intensity.

120. • Bilateral yellow colored cyst like lesion under
the macula is the unmistakable appearance
of vitelliform macular dystrophy.
• A variant called adult vitelliform dystrophy
occurs in middle-aged individuals and is
often unilateral. The lesions are smaller and
the EOG is normal.
• On FFA these lesions are characteristically
‘autofluorescent’. The cyst does not fill and in
fact masks the underlying choroidal
fluorescence.

121. • The vitelliform contents
disintegrate and liquefy showing
a fluid level giving the
appearance of a hypopyon
• A small collection of altered subretinal
blood under the fovea.

122. A subretinal cystic lesion that is translucent white in color along with a
characteristic white dot within the lesion (scolex) is the characteristic
appearance of a subretinal Cysticercus

123. White bands of subretinal fibrosis in a self settled retinal
detachment

124. • A well defined area of blotchy
pigmentation involving a sector
or a large segment of the retina
with well defined convex margins
due to spontaneous resolution of
retinal detachment
• A case of spontaneous resolution of a
superior retinal detachment with
blotches of coarse pigmentation and a
subretinal bandr running near the edge

125. A pair of dilated and tortuous vessels
emerging from a tumor is likely to
be the efferent and afferent vessels
of a peripheral capillary
hemangioma
Highly dilated and tortuous vessels,
secondary to peripheral arteriovenous
communications in Wyburn-Mason
syndrome

126. A lattice palisade degeneration or dystrophy appears as a linear, spindle/cigar
shaped lesion parallel to the ora made up of yellow spots with white lines of
sclerotic vessels criss-crossing across

127. A lattice harboring a retinal holeA large tear present at the edge of a
pigmented lattice. Such tears can
sometimes unzip the entire lattice
resulting in a giant tear